JUMP TO SECTION:

OPENING LINE:

The Affordable Care Act, otherwise known as ObamaCare, will be the thing that Americans will remember most about the presidency of Barack Obama. This is both because of the magnitude of the law itself, as well as the controversies surrounding what it took to get the law passed and those surrounding the law since then.
Steven Brill has written about ObamaCare for Time Magazine in the past and this book is an extension of that work.

THE PLOT:

I think most everyone in the United States, especially anyone who has had to pay medical bills would agree that America’s Healthcare System is insane. The argument over healthcare is not a question of whether the system is broken but rather whether the Affordable Care Act was the best way to address the problems in the system.
Stephen Brill tells the history of the ObamaCare legislation from back before candidate Obama even had healthcare as part of his campaign platform. Along the way, he gives accounts of some of the major players in healthcare legislation and some of the masters that each camp wanted to serve. Not only is the ACA highly criticized by opponents but even the people who crafted the law could not agree as to the direction it should take.
At the same time, Brill emphasizes the point that America’s Healthcare System is in need of reform. The book is full of stories about people who were doomed by the high cost of medical care and those who could not get insurance because of a pre-existing condition prior to the passage of the law.
Brill details some of the backroom deals that were made to get the healthcare industry to go along with the Affordable Care Act, deals that were made in secret as Obama was promising to be the most transparent President in American history.
The most interesting element for me was the story of the doomed launch of Healthcare.gov. I am always interested in technology and the fact that this was such an epic failure was something I wanted to know more about. The claim of the book is that you had all of these different groups working on different parts of the site but you did not have that one person who would be the unquestioned leader and would be responsible for making sure all of these parts fit together. There are times when reading the book that it is fair to ask whether the government may be an even bigger mess than the healthcare industry it was trying to fix. It is telling that there were fewer problems with the state run exchanges than with the federal healthcare website.
The book does not cover everything. While it delves into the 2012 Supreme Court decision that upheld the law, it ignores some of the lawsuits that followed that challenged specific provisions of the law. There are things that are mentioned in the book that took place after the court rendered a verdict in the Hobby Lobby case in 2014, so the decision came down within a time that it could have been included.
Also, Brill points out how people may have seen an increase in their insurance costs at first but that those increases would have been offset by government subsidies. Subsidies come up a lot throughout the text of the book. Brought up with less frequency is the economic impact those subsidies would have, given that the burden for paying those subsidies falls back on the American people. There are now more people who have access to Medicaid thanks to the ACA but what does that mean in the long run? Such questions, if brought up at all, are not dealt with in a comprehensive manner.

THE AUTHOR:

Brill is a journalist who has written about America’s healthcare system for Time Magazine and done a lot of work specifically on ObamaCare. This book is also a personal story, as Brill himself needed surgery in 2014 and it was his own medical bills that led to a lot of the questions asked in this book.
Aside from some of the criticisms I listed above, I think this is the appropriate place to point out a minor one that left a big impression on me. In Chapter 4, Brill identifies former North Dakota Senator Kent Conrad as being from Nebraska. Conrad’s correct state is mentioned elsewhere in the book. This is a minor point that has absolutely no impact on the narrative. However, the problem with such a small mistake not being corrected is that it makes me wonder what other, possibly larger, mistakes might have been missed. If that error wasn’t caught in editing, what other errors weren’t caught in editing? Maybe that’s the only mistake in the whole book, but it is not unreasonable to entertain the thought that there might be more.
One thing I did appreciate was Brill’s decision to include the actual questions he posed to President Obama and the answers he got back at the end of the book. All of the quotes made it into the text earlier, but it was nice to have it all again in one place. Also, there were some questions that he noted that the President did not answer and it is too bad because some of them were quite good.

THE NARRATION:

Dan Woren narrates this book as if he is a newscaster and this is the world’s longest news story. It was a very straight forward reading without a lot of emotional acting. This is not to suggest that the emotion of the book such as the frustration over the disastrous launch of Healthcare.gov isn’t clear in the performance. It is just that he doesn’t go over the top in conveying it.

THE PRODUCTION:

There is no music or other sound effects to be found on the track and that is for the best. There are 25 individual chapter stops and the volume level is consistent throughout the track.

FINAL THOUGHTS:

You can’t call ‘America’s Bitter Pill’ the complete story when it comes to the implementation of the Affordable Care Act. There are aspects of the law that have been delayed for years, and as a result not all of the effects of passing the law are known at this time. This is not complete because the story itself is still in progress.
After I read this book, I was left with two main thoughts. The first was my continued belief that the American Healthcare System is indeed a mess. Some of the stories that Brill lays out in the book, some of the people he encountered, will leave you scratching your head trying to make sense of it all.
I was also left thinking that some of the same things that made it difficult to reform the system are also found in the government that would be implementing those reforms. There are a number of flaws with government that are exposed in this work including leadership vacuums and turf wars among others. These flaws are inherent in the way our country is governed and are not related to one political party or the other being in charge. What do you do if the entity that is trying to fix the broken healthcare system is just as broken as the system it is trying to fix?
In truth, I had many mixed feelings while I was reading the book and I had a lot of questions when I reached the end. This does not mean that I did not enjoy reading ‘America’s Bitter Pill’. When I read a book like this, I expect that I will have mixed feelings because of the complexity of the subject matter. Actually, I enjoyed reading the book quite a bit because of those mixed emotions. It has a 17 hour running time but it did not seem that long at all. I could not put it down, even if at times I felt like there were parts of the story that were under told.

DISCLAIMER:

In the interest of full disclosure, I will mention that due to a disability I’ve had since birth, I am someone who is on Medicaid. Also, I’m not someone you could call an enthusiastic supporter of most of President Obama’s policies. I feel that when reviewing a book like this, sometimes it is helpful for me to reveal my own biases. It gives you the chance to decide how many grains of salt you may wish to take along with my commentary. I do not dismiss the fact that for some people the Affordable Care Act may have been beneficial. I am not so sure that in the long run it will benefit as many or more people than it hurts. I believe that a lot more time will need to pass before that can accurately be quantified.